Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SOM IGG SYNTHESIS INDEX-CSF

Facility

$10.35

Service Code	CPT 82784
Hospital Charge Code	900911436
Hospital Revenue Code	301
Min. Negotiated Rate	$5.69
Max. Negotiated Rate	$8.28
Rate for Payer: Cash Price	$10.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.28
Rate for Payer: Health Smart Auto/Commercial	$6.21
Rate for Payer: LLUH Dept of Risk Management WC	$5.69
Rate for Payer: Multiplan Commercial	$7.76

HC SOM IGG SYNTHESIS INDEX-CSF

Facility

$10.35

Service Code	CPT 82784
Hospital Charge Code	900911436
Hospital Revenue Code	301
Min. Negotiated Rate	$5.69
Max. Negotiated Rate	$9.30
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.21
Rate for Payer: Aetna of CA Government/Medicare	$6.21
Rate for Payer: Cash Price	$10.35
Rate for Payer: Cash Price	$10.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.28
Rate for Payer: Health Smart Auto/Commercial	$6.21
Rate for Payer: Intervalley Health Plan Commercial	$9.30
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.21
Rate for Payer: LLUH Dept of Risk Management WC	$5.69
Rate for Payer: Multiplan Commercial	$7.76

HC SOM IL 28 B POLYMORPHISM GENOT

Facility

$312.70

Service Code	CPT 81400
Hospital Charge Code	900912991
Hospital Revenue Code	309
Min. Negotiated Rate	$63.96
Max. Negotiated Rate	$250.16
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$187.62
Rate for Payer: Aetna of CA Government/Medicare	$187.62
Rate for Payer: Cash Price	$312.70
Rate for Payer: Cash Price	$312.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$250.16
Rate for Payer: Health Smart Auto/Commercial	$187.62
Rate for Payer: Intervalley Health Plan Commercial	$63.96
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$187.62
Rate for Payer: LLUH Dept of Risk Management WC	$171.99
Rate for Payer: Multiplan Commercial	$234.53

HC SOM IL 28 B POLYMORPHISM GENOT

Facility

$312.70

Service Code	CPT 81400
Hospital Charge Code	900912991
Hospital Revenue Code	309
Min. Negotiated Rate	$171.99
Max. Negotiated Rate	$250.16
Rate for Payer: Cash Price	$312.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$250.16
Rate for Payer: Health Smart Auto/Commercial	$187.62
Rate for Payer: LLUH Dept of Risk Management WC	$171.99
Rate for Payer: Multiplan Commercial	$234.53

HC SOM IL-6

Facility

$75.00

Service Code	CPT 83520
Hospital Charge Code	900913874
Hospital Revenue Code	302
Min. Negotiated Rate	$17.27
Max. Negotiated Rate	$60.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$45.00
Rate for Payer: Aetna of CA Government/Medicare	$45.00
Rate for Payer: Cash Price	$75.00
Rate for Payer: Cash Price	$75.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$60.00
Rate for Payer: Health Smart Auto/Commercial	$45.00
Rate for Payer: Intervalley Health Plan Commercial	$17.27
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$45.00
Rate for Payer: LLUH Dept of Risk Management WC	$41.25
Rate for Payer: Multiplan Commercial	$56.25

HC SOM IL-6

Facility

$75.00

Service Code	CPT 83520
Hospital Charge Code	900913874
Hospital Revenue Code	302
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$60.00
Rate for Payer: Cash Price	$75.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$60.00
Rate for Payer: Health Smart Auto/Commercial	$45.00
Rate for Payer: LLUH Dept of Risk Management WC	$41.25
Rate for Payer: Multiplan Commercial	$56.25

HC SOM IMMUNOGLOBULIN IGD

Facility

$26.40

Service Code	CPT 82784
Hospital Charge Code	900910574
Hospital Revenue Code	301
Min. Negotiated Rate	$14.52
Max. Negotiated Rate	$21.12
Rate for Payer: Cash Price	$26.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$21.12
Rate for Payer: Health Smart Auto/Commercial	$15.84
Rate for Payer: LLUH Dept of Risk Management WC	$14.52
Rate for Payer: Multiplan Commercial	$19.80

HC SOM IMMUNOGLOBULIN IGD

Facility

$26.40

Service Code	CPT 82784
Hospital Charge Code	900910574
Hospital Revenue Code	301
Min. Negotiated Rate	$9.30
Max. Negotiated Rate	$21.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$15.84
Rate for Payer: Aetna of CA Government/Medicare	$15.84
Rate for Payer: Cash Price	$26.40
Rate for Payer: Cash Price	$26.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$21.12
Rate for Payer: Health Smart Auto/Commercial	$15.84
Rate for Payer: Intervalley Health Plan Commercial	$9.30
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$15.84
Rate for Payer: LLUH Dept of Risk Management WC	$14.52
Rate for Payer: Multiplan Commercial	$19.80

HC SOM IMMUNOGLOBULINS,IGC SUBCLASS 1

Facility

$6.00

Service Code	CPT 82787
Hospital Charge Code	900911271
Hospital Revenue Code	301
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$4.80
Rate for Payer: Cash Price	$6.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.80
Rate for Payer: Health Smart Auto/Commercial	$3.60
Rate for Payer: LLUH Dept of Risk Management WC	$3.30
Rate for Payer: Multiplan Commercial	$4.50

HC SOM IMMUNOGLOBULINS,IGC SUBCLASS 1

Facility

$6.00

Service Code	CPT 82787
Hospital Charge Code	900911271
Hospital Revenue Code	301
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$8.02
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.60
Rate for Payer: Aetna of CA Government/Medicare	$3.60
Rate for Payer: Cash Price	$6.00
Rate for Payer: Cash Price	$6.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.80
Rate for Payer: Health Smart Auto/Commercial	$3.60
Rate for Payer: Intervalley Health Plan Commercial	$8.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.60
Rate for Payer: LLUH Dept of Risk Management WC	$3.30
Rate for Payer: Multiplan Commercial	$4.50

HC SOM IMMUNOGLOBULINS,IGG SUBCLASS 2

Facility

$6.00

Service Code	CPT 82787
Hospital Charge Code	900911272
Hospital Revenue Code	301
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$8.02
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.60
Rate for Payer: Aetna of CA Government/Medicare	$3.60
Rate for Payer: Cash Price	$6.00
Rate for Payer: Cash Price	$6.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.80
Rate for Payer: Health Smart Auto/Commercial	$3.60
Rate for Payer: Intervalley Health Plan Commercial	$8.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.60
Rate for Payer: LLUH Dept of Risk Management WC	$3.30
Rate for Payer: Multiplan Commercial	$4.50

HC SOM IMMUNOGLOBULINS,IGG SUBCLASS 2

Facility

$6.00

Service Code	CPT 82787
Hospital Charge Code	900911272
Hospital Revenue Code	301
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$4.80
Rate for Payer: Cash Price	$6.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.80
Rate for Payer: Health Smart Auto/Commercial	$3.60
Rate for Payer: LLUH Dept of Risk Management WC	$3.30
Rate for Payer: Multiplan Commercial	$4.50

HC SOM IMMUNOGLOBULINS IGG SUBCLASS 3

Facility

$7.24

Service Code	CPT 82787
Hospital Charge Code	900911273
Hospital Revenue Code	301
Min. Negotiated Rate	$3.98
Max. Negotiated Rate	$5.79
Rate for Payer: Cash Price	$7.24
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$5.79
Rate for Payer: Health Smart Auto/Commercial	$4.34
Rate for Payer: LLUH Dept of Risk Management WC	$3.98
Rate for Payer: Multiplan Commercial	$5.43

HC SOM IMMUNOGLOBULINS IGG SUBCLASS 3

Facility

$7.24

Service Code	CPT 82787
Hospital Charge Code	900911273
Hospital Revenue Code	301
Min. Negotiated Rate	$3.98
Max. Negotiated Rate	$8.02
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.34
Rate for Payer: Aetna of CA Government/Medicare	$4.34
Rate for Payer: Cash Price	$7.24
Rate for Payer: Cash Price	$7.24
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$5.79
Rate for Payer: Health Smart Auto/Commercial	$4.34
Rate for Payer: Intervalley Health Plan Commercial	$8.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.34
Rate for Payer: LLUH Dept of Risk Management WC	$3.98
Rate for Payer: Multiplan Commercial	$5.43

HC SOM IMMUNOGLOBULINS IGG SUBCLASS 4

Facility

$7.25

Service Code	CPT 82787
Hospital Charge Code	900910440
Hospital Revenue Code	301
Min. Negotiated Rate	$3.99
Max. Negotiated Rate	$5.80
Rate for Payer: Cash Price	$7.25
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$5.80
Rate for Payer: Health Smart Auto/Commercial	$4.35
Rate for Payer: LLUH Dept of Risk Management WC	$3.99
Rate for Payer: Multiplan Commercial	$5.44

HC SOM IMMUNOGLOBULINS IGG SUBCLASS 4

Facility

$7.25

Service Code	CPT 82787
Hospital Charge Code	900910440
Hospital Revenue Code	301
Min. Negotiated Rate	$3.99
Max. Negotiated Rate	$8.02
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.35
Rate for Payer: Aetna of CA Government/Medicare	$4.35
Rate for Payer: Cash Price	$7.25
Rate for Payer: Cash Price	$7.25
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$5.80
Rate for Payer: Health Smart Auto/Commercial	$4.35
Rate for Payer: Intervalley Health Plan Commercial	$8.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.35
Rate for Payer: LLUH Dept of Risk Management WC	$3.99
Rate for Payer: Multiplan Commercial	$5.44

HC SOM INFLUENZA A AB TITER (CF)

Facility

$14.75

Service Code	CPT 86710
Hospital Charge Code	900911771
Hospital Revenue Code	302
Min. Negotiated Rate	$8.11
Max. Negotiated Rate	$13.55
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$8.85
Rate for Payer: Aetna of CA Government/Medicare	$8.85
Rate for Payer: Cash Price	$14.75
Rate for Payer: Cash Price	$14.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$11.80
Rate for Payer: Health Smart Auto/Commercial	$8.85
Rate for Payer: Intervalley Health Plan Commercial	$13.55
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$8.85
Rate for Payer: LLUH Dept of Risk Management WC	$8.11
Rate for Payer: Multiplan Commercial	$11.06

HC SOM INFLUENZA A AB TITER (CF)

Facility

$14.75

Service Code	CPT 86710
Hospital Charge Code	900911771
Hospital Revenue Code	302
Min. Negotiated Rate	$8.11
Max. Negotiated Rate	$11.80
Rate for Payer: Cash Price	$14.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$11.80
Rate for Payer: Health Smart Auto/Commercial	$8.85
Rate for Payer: LLUH Dept of Risk Management WC	$8.11
Rate for Payer: Multiplan Commercial	$11.06

HC SOM INFLUENZA B AB TITER (CF)

Facility

$7.50

Service Code	CPT 86710
Hospital Charge Code	900911772
Hospital Revenue Code	302
Min. Negotiated Rate	$4.12
Max. Negotiated Rate	$13.55
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.50
Rate for Payer: Aetna of CA Government/Medicare	$4.50
Rate for Payer: Cash Price	$7.50
Rate for Payer: Cash Price	$7.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$6.00
Rate for Payer: Health Smart Auto/Commercial	$4.50
Rate for Payer: Intervalley Health Plan Commercial	$13.55
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.50
Rate for Payer: LLUH Dept of Risk Management WC	$4.12
Rate for Payer: Multiplan Commercial	$5.62

HC SOM INFLUENZA B AB TITER (CF)

Facility

$7.50

Service Code	CPT 86710
Hospital Charge Code	900911772
Hospital Revenue Code	302
Min. Negotiated Rate	$4.12
Max. Negotiated Rate	$6.00
Rate for Payer: Cash Price	$7.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$6.00
Rate for Payer: Health Smart Auto/Commercial	$4.50
Rate for Payer: LLUH Dept of Risk Management WC	$4.12
Rate for Payer: Multiplan Commercial	$5.62

HC SOM INHIBIN B

Facility

$50.00

Service Code	CPT 83520
Hospital Charge Code	900913934
Hospital Revenue Code	301
Min. Negotiated Rate	$17.27
Max. Negotiated Rate	$40.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$30.00
Rate for Payer: Aetna of CA Government/Medicare	$30.00
Rate for Payer: Cash Price	$50.00
Rate for Payer: Cash Price	$50.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$40.00
Rate for Payer: Health Smart Auto/Commercial	$30.00
Rate for Payer: Intervalley Health Plan Commercial	$17.27
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$30.00
Rate for Payer: LLUH Dept of Risk Management WC	$27.50
Rate for Payer: Multiplan Commercial	$37.50

HC SOM INHIBIN B

Facility

$50.00

Service Code	CPT 83520
Hospital Charge Code	900913934
Hospital Revenue Code	301
Min. Negotiated Rate	$27.50
Max. Negotiated Rate	$40.00
Rate for Payer: Cash Price	$50.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$40.00
Rate for Payer: Health Smart Auto/Commercial	$30.00
Rate for Payer: LLUH Dept of Risk Management WC	$27.50
Rate for Payer: Multiplan Commercial	$37.50

HC SOM INSULIN ANTIBODIES QUANTITATIV

Facility

$32.21

Service Code	CPT 86337
Hospital Charge Code	900911061
Hospital Revenue Code	302
Min. Negotiated Rate	$17.72
Max. Negotiated Rate	$25.77
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$19.33
Rate for Payer: Aetna of CA Government/Medicare	$19.33
Rate for Payer: Cash Price	$32.21
Rate for Payer: Cash Price	$32.21
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$25.77
Rate for Payer: Health Smart Auto/Commercial	$19.33
Rate for Payer: Intervalley Health Plan Commercial	$21.41
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$19.33
Rate for Payer: LLUH Dept of Risk Management WC	$17.72
Rate for Payer: Multiplan Commercial	$24.16

HC SOM INSULIN ANTIBODIES QUANTITATIV

Facility

$32.21

Service Code	CPT 86337
Hospital Charge Code	900911061
Hospital Revenue Code	302
Min. Negotiated Rate	$17.72
Max. Negotiated Rate	$25.77
Rate for Payer: Cash Price	$32.21
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$25.77
Rate for Payer: Health Smart Auto/Commercial	$19.33
Rate for Payer: LLUH Dept of Risk Management WC	$17.72
Rate for Payer: Multiplan Commercial	$24.16

HC SOM INSULIN-LIKE GROWTH FACTOR I

Facility

$62.50

Service Code	CPT 84305
Hospital Charge Code	900911132
Hospital Revenue Code	301
Min. Negotiated Rate	$21.26
Max. Negotiated Rate	$50.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$37.50
Rate for Payer: Aetna of CA Government/Medicare	$37.50
Rate for Payer: Cash Price	$62.50
Rate for Payer: Cash Price	$62.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$50.00
Rate for Payer: Health Smart Auto/Commercial	$37.50
Rate for Payer: Intervalley Health Plan Commercial	$21.26
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$37.50
Rate for Payer: LLUH Dept of Risk Management WC	$34.38
Rate for Payer: Multiplan Commercial	$46.88

Know your out-of-pocket cost for care.

All Charges